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KMID : 1011220210070010001
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Clinical & Experimental Thrombosis and Hemostasis
2021 Volume.7 No. 1 p.1 ~ p.6
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Diagnosis of the Adult with Suspected Acute Pulmonary Embolism
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Choi Won-Il
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Abstract
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Acute pulmonary embolism was diagnosed clinically until development of a diagnostic method to directly observe pulmonary blood vessels. In the past, diagnosis was delayed because it was based on clinical findings alone. Because of this delayed diagnosis, patients were often found to be in a serious conditions. Acute pulmonary embolism was recognized as a disease with high mortality and difficult diagnosis. Several clinical scoring systems have been developed to help diagnose pulmonary embolism. Interpreting the results of ventilation perfusion scans (V/Q scans) in conjunction with the clinical pulmonary embolism probability scores has been expanded, leading to major changes in the diagnosis of pulmonary embolism. In contrast to V/Q scans, which indirectly evaluate pulmonary blood vessels, conventional pulmonary angiography allows direct identification of pulmonary blood vessels. However, conventional pulmonary angiography is not commonly used in clinical practice due to the high degree of skill and experience needed. The development of CT technology has been remarkable and the associated contrast agents can discriminate pulmonary blood vessels when passing through the pulmonary vessels. The usefulness of CT pulmonary angiography (CTPA) based on this technique has been demonstrated. CTPA-based pulmonary embolism diagnosis has now become a standard. When linking the clinical pulmonary embolism probability score with D-dimers, the diagnostic accuracy of CTPA can be improved and unnecessary CTPA can be reduced. CTPA is widely used because it has the advantage of distinguishing between diseases other than pulmonary embolism. However, this technique has now reached a level such that over diagnosis of pulmonary embolism could be an issue. Patients for whom CTPA is difficult to perform due to hemodynamic instability may be able to aid diagnosis of pulmonary embolism indirectly through lower extremity ultrasound and echocardiography. The diagnosis of acute pulmonary embolism can be made using the clinical probability of pulmonary embolism, D-dimers, and CTPA. V/Q scans, lower extremity ultrasound with doppler, and echocardiography also play a role in diagnosing acute pulmonary embolism in certain situations.
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KEYWORD
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Pulmonary embolism, Diagnosis, Pulmonary angiography
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